Dr. Kaitlyn N. Staal
Functional Gastrointestinal Diseases and Meditation.
There is an epidemic of gastrointestinal illness in the United States. Twenty-five million people in this country alone suffer from a group of GI disorders referred to as Functional Gastrointestinal Disorders (FGID). 40% of gastroenterologist’s patient population are seen for FGID, and 50-80% of FGID sufferers defer from seeing a physician and self-medicate with over the counter drugs. There may be a better treatment option, as many studies have proven the practice of Meditation to be an excellent treatment option, alone or in conjunction with other therapies.1 The most common FGID is Irritable Bowel Syndrome, but others include functional dyspepsia, cyclic vomiting syndrome, functional gallbladder disorders, and functional anorectal pain, among many others. All FGIDs have the common theme of an intrinsic disharmony within the body system. Particularly, this can be a disharmony of the muscular activity within the intestines, altered immune responses to food and other factors, the sensitivity of innervation to the gut, a brain-gut communication dysfunction, or any combination of these.2 While conventional medicine has not yet come up with sound protocols or mechanisms of pathology, there have been several observations made pertaining to the disorder. Psychological stress exacerbates symptoms by upsetting the brain-gut communication axis. Psycho-social disturbances cause the disorder to become more severe and these patients may have an increased frequency of psychological difficulties. Lastly, and most profoundly, this GI disorder affects the sufferer’s quality of life.1 Conventional treatments include chronic steroid administration, NSAIDs and other anti-inflammatories, surgical removal of organs, antibiotics, anti-diarrheal medications, proton pump inhibitors, diet modification and stress management. Only the latter two really begin the address the underlying causation of these disorders; the rest only prove to ease symptoms temporarily and have many potential side effects with long term use. Meditation, however, has been proven to modulate the underlying pathomechanisms of this disorder.3 Meditation can actually affect the body on a molecular level as well as the physical and emotional planes. This practice therefore has the capacity for healing the gut and greatly improving patients’ quality of life. “Meditation is a complex process involving change in cognition, memory, and social and emotional control, and causes improvement in various cardiovascular, neurological, autoimmune, and renal pathologies.”4 Hormones, cytokines, the limbic system, HPA-axis, the white and gray matter of the brain and the peripheral nervous system are also influenced with a regular practice. One meditation technique often studied in relation to FGID is mindfulness-based therapy. Mindfulness-based therapy encourages the participant to be an objective observer of their body, thoughts, and surroundings, without passing judgement on these observations. “In a recent randomized controlled trial, mindfulness training has a substantial therapeutic effect on bowel symptom severity, health-related quality of life, and reduces distress in IBS patients.”2 Another study showed a reduction of IBS severity in women who practiced mindfulness therapy: “Women in the MG showed greater reductions in IBS symptom severity immediately after training, and at 3-month follow-up [...] This trial demonstrated that mindfulness training has a substantial therapeutic effect on bowel symptom severity, improves health-related quality of life, and reduces distress. The beneficial effects persist for at least 3 months after group training.”5 It is amazing how our minds have the capacity to shift cellular activity. Several studies prove this phenomenon, and many are related to FGID. Increased meditation practice has been correlated with a reduction in TSST-induced IL-6 and POMS distress scores, which “suggest that engagement in compassion meditation may reduce stress-induced immune and behavioral responses.”6 Further, in a single case study of a man who claimed to be able to actively control his immune responses via meditation, it was found that “the ex vivo pro-inflammatory and anti-inflammatory cytokine response was greatly attenuated by concentration/meditation.” He was also able to control the level of circulating catecholamines.7 A meta-analysis of alternative treatments for IBS patients found that “for psychological treatment options, such as cognitive behavioral therapy, mindfulness, gut-directed hypnotherapy, and psychodynamic therapy, the evidence supporting their use in IBS patients is strong, but the availability limits their use in clinical practice.”8 This is a very promising but also unfortunate statement. As an ND, I feel I have a responsibility to my community to be advocating for these mind-body oriented treatments and to educate my patients by training them in appropriate meditative techniques. There is such a vast population out there suffering with these disorders who are looking for the answers that meditation along with nutritional and other lifestyle shifts can provide. In doing so, FGID symptoms would be decreased by correcting root causes, and patients will have a healthier relationship with digestion and nutrient absorption. They may then be able to reduce the amount of prescriptive and over the counter drugs they take, reducing chemical loads and improving their health and quality of life. Works Cited 1. "UNC School of Medicine." What Are FGIDs? N.p., n.d. Web. 14 Nov. 2013. 2. Sandberg-Lewis, Steven. Functional Gastroenterology: Assessing and Addressing the Causes of Functional Gastrointestinal Disorders. Portland, Or.: NCNM, 2009. Print. 3. Staff, Mayo Clinic. "Irritable Bowel Syndrome." Mayo Clinic. Mayo Foundation for Medical Education and Research, 29 July 2011. Web. 14 Nov. 2013. 4. Vishal Jindal, Sorab Gupta, Ritwik Das. "Molecular Mechanisms of Meditation."Molecular Neurobiology 48.3 (2013): 808-11. Web. 24 Nov. 2013. 5. Gaylord, Susan A., Olafur S. Palsson, Eric L. Garland, Keturah R. Faurot, Rebecca S. Coble, J. Douglas Mann, William Frey, Karyn Leniek, and William E. Whitehead. "Mindfulness Training Reduces the Severity of Irritable Bowel Syndrome in Women: Results of a Randomized Controlled Trial." The American Journal of Gastroenterology 106.9 (2011): 1678-688. Print. 6. Thaddeus W.W. Pace, Lobsang Tenzin Negi, Daniel D. Adame, Steven P. Cole,Teresa I. Sivilli, Timothy D. Brown, Michael J. Issa, Charles L. Raison, Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress, Psychoneuroendocrinology, Volume 34, Issue 1, January 2009, Pages 87-98 7. Matthijs Kox, PhD, Monique Stoffels, MSc, Sanne P. Smeekens, MSc, Nens Van Alfen, MD, PhD, Marc Gomes, MD, PhD, Thijs M.H. Eijsvogels, PhD, Maria T.E. Hopman, MD, PhD, Johannes G. Van Der Hoeven, MD, PhD, Mihai G. Netea, MD, PhD and Peter Pickkers, MD, PhD. "The Influence of Concentration/Meditation on Autonomic Nervous System Activity and the Innate Immune Response: A Case Study." Psychosomatic Medicine: Journal of Biobehavioral Medicine. N.p., 29 June 2011. Web. 24 Nov. 2013. 8. Asare, Fredrick Störsrud, Stine; Simrén, Magnus Curr. "Meditation over Medication for Irritable Bowel Syndrome? On Exercise and Alternative Treatments for Irritable Bowel Syndrome." Gastroenterol Rep, 4 Aug. 2012. Web. 24 Nov. 2013.